Symptoms of Hypocalcemia
Hypocalcemia can cause a wide range of symptoms from mild to life-threatening, with the most common manifestations including neuromuscular irritability, tetany, seizures, fatigue, and cardiac arrhythmias. 1
Clinical Manifestations
Neuromuscular Symptoms
- Paresthesias (tingling/numbness) of hands, feet, and perioral region 1, 2
- Muscle cramps and spasms 1, 2
- Tetany (painful muscular contractions) 2, 3
- Tremors and rigidity 1
- Laryngospasm (potentially life-threatening) 2
Neurological Symptoms
- Seizures (may be the first sign of hypocalcemia) 1, 4
- Irritability and emotional changes 1
- Confusion or altered mental status 1
- Behavioral changes 1
Cardiovascular Symptoms
Other Symptoms
Risk Factors and Precipitating Events
Hypocalcemia risk increases during:
- Biological stress (surgery, childbirth, infection) 1
- Perioperative periods 1
- Acute illness 1
- Puberty 1
- Pregnancy 1, 5
- Decreased oral intake 1
- Consumption of alcohol or carbonated beverages (especially colas) 1
Diagnostic Considerations
- Measure pH-corrected ionized calcium (most accurate) 1
- Check parathyroid hormone (PTH) levels to determine if hypoparathyroidism is present 1
- Assess magnesium levels (hypomagnesemia can contribute to hypocalcemia) 1
- Monitor thyroid function (hypothyroidism may be associated) 1
- Check renal function (creatinine) 1
Treatment Approaches
Acute Symptomatic Hypocalcemia
- Intravenous calcium gluconate (100-200 mg elemental calcium) for rapid correction of severe symptoms 5, 2
- Monitor for resolution of symptoms 2, 3
- For seizures due to hypocalcemia, calcium supplementation is the primary treatment rather than anticonvulsants 4
Chronic Hypocalcemia Management
- Daily calcium and vitamin D supplementation 1
- Magnesium supplementation if hypomagnesemia is present 1
- For severe cases, hormonally active vitamin D metabolites (calcitriol) may be needed (consult endocrinologist) 1
- Targeted monitoring of calcium concentrations during vulnerable periods 1
- For hypoparathyroidism, recombinant human PTH may be considered in select cases 6
Important Considerations and Pitfalls
- Hypocalcemic seizures may not respond adequately to anticonvulsant medications alone 4
- Some anticonvulsants may actually worsen hypocalcemia 4
- Overcorrection of calcium can lead to hypercalcemia, renal calculi, and renal failure 1
- Symptoms of hypocalcemia may be confused with psychiatric conditions 1
- In pregnant patients, maternal hypocalcemia can lead to fetal hyperparathyroidism and skeletal demineralization 5
- Aluminum toxicity is a concern with calcium products in premature neonates due to immature renal function 5
Regular monitoring of calcium levels is essential for patients with chronic hypocalcemia, with special attention during periods of increased risk 1.